Provider Demographics
NPI:1558711382
Name:WETHERWAX, NATALIE JOY (SLP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:JOY
Last Name:WETHERWAX
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:JOY
Other - Last Name:CAVALIERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4564 HARRISON BLVD APT 8
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3168
Mailing Address - Country:US
Mailing Address - Phone:585-322-5265
Mailing Address - Fax:
Practice Address - Street 1:45 E STATE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2344
Practice Address - Country:US
Practice Address - Phone:801-402-5261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026715-1235Z00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program